I recently came across a patient who asked about a capsule that I prescribed and asked if the medication came in a tablet form. Further inquiry revealed that the gelatin capsule was of porcine (pig) origin and his Muslim faith proscribed any products derived from pigs especially if there were alternatives. This conversation alerted me to the cultural differences of different faiths or patients who have different dietary preferences. This article will focus on just medications and dietary differences of various cultures and religions.

There is an ever-growing diversity of religious beliefs in the U.S. that urologists need to take into account during our interactions with patients. Several world religions, including Islam, Judaism and Hinduism, prohibit their followers from consuming certain foods and drinks. For instance, alcohol, pork and/or beef products, or those not prepared in specified ways according to strict guidelines are not permitted. These restrictions are not only based on religious exclusions but also include vegans and vegetarians who restrict their consumption of animal-derived products. I did some research on this subject and found that many medications contain at least 1 active or inactive ingredient derived from prohibited sources.¹ Many of our colleagues, myself included, are unaware that some of these ingredients might be in their medicines, and we should be sensitive to our patients’ views and restrictions.

If there are concerns about certain medications that are derived from animals or use alcohol as an ingredient or in the preparation of the medication, then we need to be able to define and explain the medical necessity and to explore the possibility of suitable alternatives.

Another caveat is the awareness of patients who fast, as it may be necessary to make modifications to a patient’s medication regimen during the fasting period. For example, during the month of Ramadan, patients of the Muslim faith may not take medications, eat or drink from sunrise to sunset. If fasting puts the patient’s health at risk, then doctors need to communicate the risks and advise the patient to seek the advice of their religious leaders or imams. It has been my observation that most religious leaders allow patients to do whatever is medically necessary to protect their health.

Religious Jews adhere to a set of dietary laws (Kosher) that determine what food and drink are permitted. They do not eat any products from pigs and do not eat shellfish (lobster, clams, mussels) or shellfish products. Examples of those medications with active ingredients directly derived from animals include heparin, an injectable anticoagulant which is commonly extracted from porcine intestinal mucosa, and conjugated estrogens, used in some hormone replacement preparations and derived from pregnant mares’ urine. Supplements with active ingredients that come from animal products include calcium tablets, from animal bones; glucosamine, from shrimp, lobster and crab shells; chondroitin from shark, bovine or porcine cartilage; and heme iron supplements, from animal blood.

Seventh-day Adventists are encouraged to eat a vegetarian diet and have prohibitions on pork, alcohol, coffee and tea.

Bottom line: in our culturally diverse nation, we need to be sensitive to patients with diverse values, beliefs and behaviors. A culturally competent urologist acknowledges the importance of culture, understands cultural differences, recognizes the potential impact of cultural differences in the care we provide our patients of different backgrounds and adapts services to meet the unique needs of our culturally different patients. Ultimately, cultural competency puts us on a path to also recognize racial and ethnic disparities in health care.

An open dialogue between the urologist and the patient is necessary, so that consideration can be given to the patient’s religious beliefs before prescribing drugs or treatment.